HomeMy WebLinkAbout11-14-12J 15175610143
REV-1500 Ex(°'-'°'
PA De artment of Revenue OFFICIAL USE ONLY
P Pennsylvania County Cotla vear Fiie Namoer
Bureau of Individual Taxes aE^M*aa^~~aA'~~
Po eox.zsosot INHERITANCE TAX RETURN 21 12 0822
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
16 2012 12 30 1949
Decedent's Last Name Suffix Decedent's First Name MI
EARS JR JACK C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ qa_ Futura Interest Compromise ~
(date M tleath afler 12-12A2) 5. Federal Estate Tax Return Required
G g Decedanl Died Testate
(Attach COpyM Will) ~ T ew~e°t Maint natl a Living Tmst O
(Alta Gopy of~rust) S Total Number of Safe De Oait Boxes
p
9. Litigation Proceeds Received ~ 10. EaRVaeo1[v31 ~~rae~at,~EatgeSa death ~ 11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROB BLEECHER ESQ 717 691 9808
REGISTER OF WILLS USE ONLY
First line of address ~ ~a
~"
O -~, xi
1205 MANOR DRIVE ~=° ? n
Second line of address
_
n.
C:;
SUITE 200 i=~`;' ~ _ c~~
City or Post Otfice
State ZIP Code FILED ~
-
- `:3
r
MECHANICSBURG PA 17055 _
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THAN REPRESENTATIVE
Rob Bleecher, Esquire
PA 17055
1505610143
Side 1
1505610143 J
1505610243
REV-1500 EX
(Decedent's Social Security Number
oaceaanrs Name. Eads, Jack C Jr
RECAPITULATION
1. Real Estate(Schedule A) ...................................................................................... . 1. 145,000.00
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2.
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)........ . 3.
4. Mortgages & Notes Receivable (Schedule D) ....................................................... . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 32 , 810.99
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested............ 7,
8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 177 , 810.99
9. Funeral Expenses 8 Administrative Costs (Schedule H) ............................... ........ 9. 13 , 314.13
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..................... ......... 10. 137 , 937.16
11. Total Deductions (total Lines 9 & 10) .......................................................... ......... 11. 151 , 251.2 9
12. Net Value of Estate (Line 8 minus Line 11) .................................................. ........ 12. 2 fi , 559.70
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ....................................... ........ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................................... ......... 14. 2 6 , 559.70
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable 26 559.70 1s.
at lineal rate X .045 r
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due .................................................................................................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243
0.00
1,195.19
0.00
0.00
1,195.19
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-12-0822
DECEDENT'S NAME
Eads, Jack C Jr
STREETADDRESS
110 Hillcrest Road
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
Total Credits (A + B) (2)
0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
to:
OF
(1) 1,195.19
(3)
(4)
(s) 1,195.19
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :............................................................................... ^
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x
c. retain a reversionary interest; or ......................................................................................_....................... ^ ^x
d. receive the promise for life of eRher payments, benefits or care? ................................................._......... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate wnsideration? .................................................................................................................... ^ ^x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properky which
contains a bene0ciary designation? .................................................................................................................. ^
IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1502 EX« (11-08)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TPX RETURN
RESIDENT pECEOENT
ESTATE OF (FILE NUMBER
Eads, Jack C Jr 21-12-0822
All real property ownetl adely or as a tenant In common must ba reported et fair market value. Fair market value is defined as the price at which property would be
exchafgetl between a willing buyer and a willing seller, neither being mmpeiletl to buy or sell, both having reasonable knowledge of the relevant facts.
Reel property which Is jolndycwnetl with right of surWVOnhlp must be tllaclosetl on achaduls F.
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08)
(If more space is neetled, additional pages of the same size)
Rev-7608 EX* (B-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSVLVANIR
INHERITANCE TAX RETURN
0.EEIDENT DECEDENT
ESTATE OF (FILE NUMBER
Eads, Jack C Jr 21-12-0822
Indutle the proceeds of litigation end the date the proceetls were received by the estate.
All pmpeM1y lolntlycwned with the right of surWvonhip must ba diaclosad on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Members First Federal Credit Union -Checking Account -15194-11 -Mechanicsburg, PA 312.86
17055
2 Members First Federal Credit Union -Savings Account -15194-00 -Mechanicsburg, PA 631.63
17055
3 1999 Jeep Wrangler -Value per Kelly Blue Book 4,045.00
4 2005 Jeep Liberty -Value per Kelly Blue Book 8,301.00
5 Furnishing and Personal Property 19,520.50
TOTAL (Also enter on Line 5, Recapitulation) I 32,810.99
(It more space is needed, atlditional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-7767 EXi 170-06)
COM~~4T,~D~F~ANIA
SCHEDULE H
FUNERAL EXPENSES &
ESTATE OF FILE NUMBER
Eads, Jack C Jr 21-12A822
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 2,849.18
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio _
Year(s1 Commission paid
2. Attorney's Fees Pecht 8 Associates, PC 10,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio _
Relationship of Claimant to Decedent
4. Probate Fees 88.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 376.45
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 13,314.13
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Eads, Jack C Jr 21-12-0822
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Neil Funeral Home -Additional Death Certificates - 3501 Derry Street, Harrisburg, PA 90.00
2 Neil Funeral Hame -Funeral Expense - 3501 Derry Street, Harrisburg, PA 2,759.78
H-A 2,849.18
3 Other Admini~rative Costs
Cumberland Law Journal -Estate Legal Advertisement
75.00
4 Gunn -Mowery, LLC - Admiistrator's Bond -Camp Hill, PA 17001 135.00
5 Register of Wills, Cumberland County -Filing Fee -Inheritance Tax Return and Inventory 30.00
6 Register of Wills, Cumberland County -Filing Fee -Estate Settlement Agreement 20.00
7 The Patriot Newts -Estate Legal Advertiement 116.45
H-67 376.45
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 E%~ (12-09)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTHOF PENNSYLVANIA
INHERITANCE TAX RETURN
RESILENT LELEOENT
ESTATE OF FILE NUMBER
Eads, Jack C Jr 21-12-0822
Report debts incumd by the decadent prior to death that remainstl unpaid at the data of death, including unreimburaed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 ABC Fuel Oil Company -Heating Oil -110 Hillcrest Road, Camp Hill, Pa 605.02
2 Bank of America, VISA -Credit Card 6.93
3 BIS Home Inspection Service -Mold Inspection and remidiation - 710 Hillcrest Road, Camp 700.00
Hill, PA
4 Camp Hill Emergency Physicians, Philadelphia, PA -Holy Spirit Hospital Emergency Room 806.00
Physician Services
5 Capital One, Mirfneapolis, MN -Credit Card Debt 8,347.62
6 Cindy Fenton, Duncannon, PA -Commission Fees 10,944.13
7 Comcast -Cable, Internet, and Telephone Services 186.73
8 Cumberland County Real Estate and Per Capita Taxes 2,057.37
9 Cyrus and Susan Copenhaver -Reimbursement fro travel and costs advanced 1,680.00
10 Dugan Appraisal Services -Appraisal -110 Hillcrest Road, Camp Hill, PA 300.00
11 Goodall Pools -Winterize and close pool at 110 Hillcrest Road, Camp Hill, PA 763.21
12 Hampden Township Emergency Medical Services -Mechanicsburg, PA 17050 734.50
13 Holy Spirit Hospital -Emergency Room g2g,2g
14 Knisely Landscaping - Lawnmowing services 110 Hillcrest Road Camp Hill, PA 656.50
15 LB Smith Ford -Deductible for repairs to 2005 Jeep Liberty 150.00
16 Lowes, Atlanta, GA -Credit Card 1,366.53
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 10, Recapitulation) 137,937.16
(If more Space is nestled, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule I (Rev. 12-08)
Revd611 EX+I6-96)
LOMMONWEALTHOF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OELEOENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8 LIENS
continued
ESTATE OF FILE NUMBER
Eads, Jack C Jr 21-12-0822
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
17 Members First Credit Union -Personal Signature Loan 8,123.01
18 Members First Federal Credit Union -VISA Credit Card 9,308.77
19 Members First Federal Credit Union -Vehicle Loan - 2005 Jeep Liberty 2,653.33
20 Pecht & Associates, PC -Reimbursement for Filing Fee - Administretrtix Bond 15.00
21 Pecht & Associates, PC -Purchase of Dehumidifier for 110 Hillcrest Road, Camp Hill, PA 181.24
22 Pennsylvania American Water Company, Pittsburgh, PA -Utility 296.40
23 PPL, Allentown, PA -Electric Utility Service 312.24
24 Sears Master Card, Columbus, Ohio -Credit Card 2,007.37
25 Sudden Death Termite & Pest Control -Termite Pest Inspection 50.00
26 Summit Locksmith, Harrisburg, PA -Locksmith Services, 110 Hillcrest Road, Camp Hill, Pa 392.60
27 The Hartford -Automobile Insurance for Southwind, 2005 Jeep Liberty, and Jeep Wrangler 490.72
28 US Bank Home Mortgage, Owensboro, KY -Mortgage 110 Hillcrest Road, Camp Hill, PA 83,245.80
29 Verizon Wireless -Wireless Telephone Service 354.95
30 West Shore EMS, Camp Hill, PA -Emergency Ambulance Transport 1.172.91
TOTAL (Also enter on Line 10, Recapitulation)
137,937.16
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
LIMITED POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that I, Stephanie L. Eads, of 4530
Martin Street, Moss Point, Mississippi, have made, constituted, and appointed my
attorneys Wayne M. Pecht and Rob Bleecher, my true and lawful agents and attorneys, in
my name, place and stead, for the limited purpose of acting on my behalf in the
administration of the Estate of Jack C. Eads, Jr., including but not limited to disposal of
all personal property and selling the real property known as 110 Hillcrest Drive, Camp
Hill, Cumberland County, Pennsylvania, being identified as Parcel No. 10-21-0277-028
(the "Property") in the following manner:
1. To do and perform all matters and things, transact all business, make,
execute and acknowledge all deeds, notes, mortgages, affidavits, acknowledgments,
disclosures, certificates or other bank forms that may be requisite or proper in selling the
personal property and real property with the same powers, and to all intents and purposes
with the same validity as I could if personally present. It is my intention in this paragraph
to give my Agents and Attorneys-In-Fact, Wayne M. Pecht and Rob Bleecher, the
broadest possible power, with regazd to any of the kinds or classes of matters or powers
specifically enumerated above.
2. My agent may delegate any one or more powers granted herein to one or
more persons and on such terms as the agent may designate and specify.
3. I understand and am cognizant of the meaning and import of this limited
power of attorney, and am legally and mentally competent to offer is to Wayne M. Pecht
and Rob Bleecher to act on my behalf and legally bind me in the sale of the personal
property and real property.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this ls` day of
August, 2012.
O
Stephanie L. Eads
1n the presence of:
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.:
On this, the ~~-day of August, 2012, before me, the undersigned officer,
personally appeared Stephanie L. Eads, lcrlown to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and aclcncrwledged that he
executed the same for the purposes therein contained.
CCMMCNWEFLT;+. t',_' PENNSYLVANIA
NOTA`z1F'aL SEAL
Lori A. Backenstoes-Notary Public
Lower Allen "?w'~., Cumberland County
MY COMMIS`_"" "'°'"FS OCT. 13, 2015
~~r
Notary Pub lc